Limited pelvic radiotherapy in post-operative uterine carcinoma

Adjuvant external beam radiotherapy (EBRT) is a standard of care for all patients with intermediate and high-risk uterine carcinomas. In EBRT, target volume includes tumour bed along with pelvic lymph nodes. However, benefit of nodal irradiation in patients with negative nodes after an adequate pelvic lymph node dissection is unclear. This retrospective study aims to analyse outcome of limited pelvic radiotherapy (LPRT) in postoperative carcinoma of cervix and endometrium.

All postoperative carcinoma of cervix and endometrium cases treated with adjuvant LPRT from January 2013 to December 2023 were included in the analysis. Patients were treated to a dose of 5040 cGy using 3-dimensional conformal radiotherapy. In patients with cervical stroma involvement, along with an EBRT dose of 4500 cGy, high dose rate (HDR) brachytherapy was also delivered. We plan analysed patterns of failure, overall survival (OS), recurrence-free survival (RFS), and treatment-associated toxicities.

Out of 391 screened postoperative carcinoma cervix and endometrium patients, 37 received LPRT. With a median follow-up of 51.1 months, 2 patients were lost to follow-up. The 5-year RFS and OS were 75.5% and 73.2%, respectively. Among 4 patients who developed recurrence during the 5-year analysis period, all had distant recurrences. Grade ≥ 2 gastrointestinal and genitourinary toxicities were observed in 29.7% of patients in acute phase and 2.7% as late effects. Lymphedema occurred in 8.1%, with no Grade 4 or 5 toxicities reported.

LPRT without lymph node irradiation results in good local control in the selected group of post operative uterine carcinomas.